Endemic Zone Research Articles

Epidemiological and Clinical Features of Melioidosis: A Report of Seven Cases from Southern Inland China.

Some subtropical regions with similar climatic conditions to melioidosis-endemic areas, such as southern Guangxi, may be new endemic zones for melioidosis. We retrospectively reviewed seven culture-proven melioidosis patients from October 2006 to March 2015. Their clinical characteristics, diagnosis, and treatment, and the geographical and environmental factors were analyzed. Seven male patients lived at latitudes of 21-23°N in Beihai, Nanning, Chongzuo City of the Guangxi Province. Symptom onset occurred during the rainy season. All patients had pneumonia, six patients had diabetes, five patients had a history of wounds or exposure to soil or water, and two patients had liver and spleen abscesses. Most patients were misdiagnosed before the confirmatory laboratory testing. The final diagnosis was confirmed as melioidosis by isolation of Burkholderia pseudomallei in a culture of blood or pus. The 6- to 17-month treatment included carbapenems, ceftazidime, or other antibiotics active against the organism in vitro. All patients initially appeared cured, but two subsequently had recurrent melioidosis. In non-highly endemic areas, there is often a lack of awareness of melioidosis, and this leads to misdiagnoses. Other subtropical regions with climatic conditions similar to the highly melioidosis-endemic areas such as southern Guangxi may also be melioidosis endemic.

Comparative evaluation of immunochromatographic dipstick test (ICT) rk39, soluble antigen ELISA and IFAT for the sero-diagnosis of visceral leishmaniasis in Morocco

A rapid, sensitive and specific tool for detection of Leishmania infantum infection in Humans would be highly desirable, because it would allow control interventions in endemic areas of visceral leishmaniasis. This study was carried out at the Reference National Laboratory of Leishmaniasis (RNLL) in National Institute of Hygiene (NIH) Morocco, in order to evaluate the diagnostic potential of immunochromatographic dipstick test (ICT) rk39 in Moroccan suspected VL patients. A total of 49 admitted patients with strong clinical suspicion of VL and 40 healthy controls were investigated for the performance of the ICT rk39. Bone marrow smears were examined for microscopic detection of Leishmania amastigotes obtained from the admitted patients. Only PCR and smear positive cases were considered as gold standard as well as confirmed cases of VL. Out of 49 suspected patients, twenty four (48.9%) were found PCR and smear-positive and twenty three (46.9%) were positive for ICT rk39. Voluntary healthy controls, which included twenty persons from the endemic zone and twenty from non-endemic zone of VL, were found all negative for the strip test. The sensitivity in sera was 75% by ELISA and 87.5% by IFAT, compared with 95.8% for ICT rk39. Specificity was 95.8%, with both tests ELISA and IFAT, and 100% by ICT rk39 respectively. Present study findings again reinforce that the ICT rk39 is a simple, reliable and easy-to-perform non-invasive diagnostic tool for visceral leishmaniasis in the endemic area of Morocco.

APPLICATION OF MONOCLONAL ANTIBODY-BASED LATEX AGGLUTINATION TEST FOR DETECTION AND IDENTIFICATION OF THE AGENT OF MELIOIDOSIS IN CLINICAL AND ENVIRONMENTAL OBJECTS

The review summarizes the basic information on the development and diagnostic capabilities of the latex agglutination test (LAT), used for detection and subsequent identification of melioidosis pathogen. According to the published literature, the use of melioidosis monoclonal antibodies of various epitope direction for coat the latex beads (suspension carrier), the main detection ingredient of this reaction, contributes to an increase in the diagnostic capabilities of this method: its sensitivity and specificity, which has been repeatedly confirmed by specialists working both in endemic zone distribution of Burkholderia pseudomallei and outside these territories. As most authors of the publications noted, after introduction of this reaction into practical work of profile laboratories, low-cost commercial products (test set of reagents for latex agglutination reaction) can find wide application both in stationary and mobile laboratories. The undoubted merits of the method are its simplicity, clarity, suitability for working with various samples from objects of the external environment and biological material, as well as obtained evidence ofthe suitability of LAT to ensure effective differentiation of B. pseudomallei from avirulent related bacteria and detection of the causative agent in the early stages of the disease for relatively short intervals, which makes it a promising method for diagnosing melioidosis, a potentially fatal infection requiring an early onset appropriate antibiotic therapy.

Cross-border issues: an important component of onchocerciasis elimination programmes.

Endemic areas that involve national or local borders present an important challenge to the success of elimination of onchocerciasis; such cross-border endemic foci require special attention to ensure that programme activities are unified. It is vital that national programmes and the committees responsible for the oversight of progress towards elimination are aware and address such issues in their current planning and programmatic activities. Although international borders that intersect endemic zones present the biggest challenge, intracountry borders (such as between administrative districts or loiasis endemic and non-loiasis areas) can also pose problems. The recent change in the onchocerciasis programme from disease control to transmission interruption, given the historical lack of treatment in hypo-endemic areas, may have increased the already relatively high number of cross-national scenarios in Africa. It is vital that all national programmes address the issue of any cross-border endemic areas as a matter of urgency and include this important issue in their elimination plans.

Second five-year follow-up after a booster vaccination against tick-borne encephalitis following different primary vaccination schedules demonstrates at least 10 years antibody persistence

BackgroundTick borne encephalitis (TBE) endemic zones are expanding. We previously evaluated long term persistence of antibody 5 years after the first booster immunization following different primary immunization schedules with the polygeline-free inactivated TBE vaccine (TBEvac) in adults and adolescents. Here, we report anti-TBE virus (TBEV) antibody persistence from 6 to 10 years post-booster administration. MethodsThis was a phase IV, open-label, single-center, second extension study (NCT01562444), conducted in Czechia. Healthy adults and adolescents ≥12 years who had received 3 different primary vaccination schedules (rapid, conventional and accelerated conventional) in the parent study and a booster dose before (12–18 months post-primary series completion) or at the beginning (3 years post-primary series completion) of the first extension study were screened and enrolled in this study. Blood samples were collected yearly and anti-TBEV antibody response was evaluated by neutralizing test (NT) antibody assays. Analysis was performed overall and per age strata: 15–49 years, ≥50 years, and ≥60 years. ResultsOf 206 screened individuals, 191 completed the study. Overall, 90–100% of participants in the all-screened set and ≥97% in the per-protocol set had the clinically meaningful threshold of protection (NT titers ≥10) across all timepoints, regardless of the primary vaccination schedule. Overall, antibody geometric mean titers (GMTs) varied from 134 to 343 in the all-screened set. Older age groups showed overall lower GMTs, although GMTs remained higher than NT titers ≥10 up to year 10 in all groups. ConclusionThis study showed long-term persistence of anti-TBEV NT antibodies for up to 10 years after the first booster dose of TBEvac in all age groups, regardless of the primary vaccination schedule.

Risk factor analysis associated with Theileria equi infected equines in semi-arid and sub-humid ecological enzootic zones of India.

Equine piroplasmosis is a haemoprtozoan disease of equines and enzootic in tropical and subtropical countries. A cross-sectional study on sero-prevalence of Theileria equi, the causative agent of EP, was performed in semi-arid and sub-humid ecological endemic zones of India including Rajasthan, Haryana and Gujarat states, in order to evaluate the enzootic status/level of exposure to equine population due to this infection and addressed associated risk factors. Serum samples were collected from a total of 1021 equids that comprised of 792 horses, 168 donkeys and 61 mules and evaluated for T. equi specific antibodies in equine merozoite antigen-2 (EMA-2) based on indirect ELISA. The state with high sero-prevalence rate was Rajasthan (71.40%), followed by Haryana (60.39%) and Gujarat (48.92%). Overall T. equi sero-positivity in equines was 64.44%. Species-wise T. equi sero-prevalence was 66.29%, 51.19% and 91.80% in horses, donkeys and mules respectively. The association and risk factor among age, gender and species in relation with T. equi infection was statistically analyzed at 95% level of significance (p<0.05). A very high T. equi sero-positivity was recorded in 0-1year age group of equines (60%), indicating that this naïve age group contacts with T. equi infected ticks and remains infected throughout its lifetime. The sero-prevalence rate was significantly associated with the species of animal (p<0.05). The risk factor analysis kept mules at higher risk (Odd's ratio; 5.696; 95% confidence interval: 2.25-14.38) of getting infection as compared to horses and donkeys. This study has demonstrated high enzootic nature of T. equi infection in semi-arid and sub-humid ecological zones of India. Mules, in comparison to horses and donkeys were found at higher risk of getting T. equi infection, indicating that disease prevalence is associated with species of the infected host.

A novel double-antigen sandwich ELISA for the species-independent detection of Crimean-Congo hemorrhagic fever virus-specific antibodies

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease in humans caused by the CCHF virus (CCHFV). The detection of anti-CCHFV antibodies in animals is used to reveal infection risk areas. Therefore a simple, quick and reliable multispecies assay for the detection of CCHFV-specific antibodies is needed. This work presents the development and validation of a novel CCHF double-antigen ELISA for the detection of anti-CCHFV nucleoprotein antibodies. The test requires 30 μl of serum, and results are obtained within 90 min. As the ELISA is based on recombinant N-protein of the IbAr10200 virus, it can be run under standard biosafety conditions. For assay validation, sera from 95 cattle and 176 small ruminants from CCHF-endemic regions (origin: Albania, Cameroon, Kosovo, Former Yugoslav Republic of Macedonia, Mauritania, Pakistan, Turkey) served as a positive reference serum panel. The CCHF antibody status of the positive reference samples had been previously confirmed by two serological assays (species-adapted VectorBest ELISA and Euroimmun IFA). CCHFV strains belonging to three different clades are known to circulate in the countries where the positive samples originated. Sera from 402 cattle and 804 small ruminants from Germany and France served as the negative serum panel, as both countries are considered outside of the CCHFV endemic zone. Sera from monkeys, camels, rats, ferrets, raccoon dogs, raccoons, foxes, hares, pigs and humans were also tested, to determine the suitability of this novel ELISA for these species. All negative reference sera were confirmed by the CCHF double-antigen ELISA, indicating a specificity of 100%. 268 of 271 positive reference sera tested positive for CCHFV-specific antibodies, 8sensitivity of 99%9. Further analysis are needed to ensure a recognition of the IbAr10200 nucleoprotein by antibodies directed against all known CCHFV clades. This is planned to be realized with sera from other regions covering the three missing clades.

Seroprevalencia de infección por Trypanosoma cruzi y factores asociados en Miraflores Boyacá, Colombia

Introducción. La enfermedad de Chagas es causada por el parásito Trypanosoma cruzi, se transmitecuando las heces infectadas de vectores triatomineos tienen contacto con el huésped por medio deuna picadura o a través de una membrana mucosa; otras vías de infección incluyen transfusiones,transplantes y transmisión congénita y oral. En Miraflores es una enfermedad de gran endemia quenecesita búsqueda activa de casos.Objetivo. Determinar la seroprevalencia de la infección por T. cruzi y los factores asociados con laenfermedad de Chagas en el municipio de Miraflores en el departamento de Boyacá, Colombia.Materiales y métodos. Se trata de un estudio observacional, analítico y de corte transversal. Se determinóla seropositividad en 166 muestras de suero mediante las técnicas ELISA IgG-IgM y ELISA recombinante,considerando positivas aquellas que fueron reactivas en las dos pruebas. Se indagó sobre lascaracterísticas sociodemográficas y los factores relacionados con la infección por el parásito T. cruzi.Se determinó la asociación de las variables mediante odds ratio y significancia estadística con p&lt;0,05.Resultados. La seropositividad para infección por T. cruzi fue de 7,8 % y se estableció que ser mayor de41 años se relacionó con una mayor frecuencia de seropositividad (OR=5,0; IC95% 1,2-34,0; p=0,04).Conclusiones. El estudio de zonas endémicas ayuda a identificar personas infectadas que son asintomáticas,las cuales pueden acceder a tratamientos oportunos. En Miraflores, el 7,8 % de la población puedeacceder a este beneficio, además, permite establecer una línea epidemiológica de base que contribuyaal control de la enfermedad en el municipio.

Portal Vein Thrombosis with Tropical Splenomegaly-A Rare Coincidental Finding

Tropical splenomegaly syndrome has rarely been associated as a cause of portal hypertension in patients living in endemic malarial zone. TSS has however has never been reported to be associated with portal vein thrombosis. We report a case of a 17 year old male who presented with features of portal hypertension and on radiological evaluation was found to have portal vein thrombus with cavernoma formation. Liver biopsy was performed for ruling out other pathologies and cirrhosis and was found to have hemozoin pigment along with features of inflow vascular pathology. We here in report first case of tropical splenomegaly with portal vein thrombosis.

Pancreatic tuberculosis causing biliary obstruction and mimicking pancreatic malignancy

Tuberculosis (TB) is a bacterial infection which can affect any part of the body from head to toe and has various presentations depending on the site of the infection. Pancreatic TB is very rare and usually happens as a part of disseminated or miliary TB, whereas isolated pancreatic TB is even rarer. Here, we present a case of pancreatic TB at a TB endemic zone which presented with obstructive jaundice and pancreatic lesions mimicking pancreatic malignancy. A 46-year-old Saudi female patient presented with right upper quadrant abdominal pain associated with dark coloured urine and pale stool. The patient had been admitted to the surgical ward as a case of acute cholecystitis for further evaluation. On abdominal ultrasound (US), findings demonstrated dilated common bile duct (CBD), but the distal part was difficult to be visualised; hence, further evaluation by magnetic resonance cholangiopancreatography (MRCP) was recommended to look for CBD stones. The MRCP showed two focal pancreatic lesions causing the distal CBD obstruction with no stones at CBD. Based on these findings, malignancy was considered and computed tomography-guided fine-needle aspiration biopsy from the pancreatic neck lesion was performed. This demonstrated multiple granulomas and lymphocytes with no malignant cell which indicated pancreatic TB. The patient became well after a course of anti-TB medications. pancreatic TB should be included in the differential diagnosis of pancreatic masses, especially in those patients who live in an endemic area of TB. A biopsy is necessary to establish the diagnosis and start the appropriate treatment for this curable disease as soon as possible.

Histoplasmosis in Non-endemic North-Western Part of India

Purpose of Study: The western and North-Western parts of India are usually considered non-endemic for histoplasmosis. On the contrary, we observe histoplasmosis cases with relatively higher frequency from this region although the awareness and laboratory facility to diagnose the disease are not adequate. Hence, we planned the present retrospective study to compile the cases and to analyse different clinical parameters. Materials and Methods: Medical records of the patients diagnosed with histoplasmosis during January 2012–August 2017 at two infectious disease clinics of Ahmedabad were included in this study. Results: During the study, 12 cases of histoplasmosis were diagnosed. The median age of the patients was 53 years; all males except one. The diagnosis of histoplasmosis was confirmed on histopathology for 11 cases, and one patient was diagnosed as probable histoplasmosis. The patients were either from Gujarat or Rajasthan without any travel history to endemic zone of histoplasmosis, except one patient. The majority (67%) of the patients had no apparent immunosuppression. Adrenal enlargement, oral ulcers and lymphadenopathy were common presentations in four patients each. We lost two patients in follow-up, and rest 10 patients responded to either to amphotericin B deoxycholate and/or itraconazole therapy. Conclusion: This study highlights that Gujarat and Rajasthan are an endemic region for histoplasmosis, and a systematic study is required to understand epidemiology of the disease. Histoplasmosis should be a differential diagnosis in a patient presenting with adrenal enlargement, lymphadenopathy, oral ulcers and fever of unknown origin in this region.

The Prevalence of Hepatitis B, Hepatitis C and HIV among Medical Waste Workers in Khartoum State Hospitals, Sudan (2013 – 2016)

This descriptive study was done in Khartoum State Hospitals and the aimed to determine prevalence of HBV, HCV, and HIV among medical waste workers in period 2013 – 2016, Eight hospitals with different specialties and different size were selected in the study and 300 workers were involved in the study, all in filled questionnaire and blood sample for analysis hepatitis B, (HBV) hepatitis C (HCV) and human immunodeficiency virus (HIV) using ELISA tests. , 27% of the workers were diagnosed to have hepatitis B before and 56, 7% were vaccinated against HBV. Prevalence of HBV, HCV and HIV among medical waste workers in this study is in the intermediate zone of endemicity, 5.7%, 0.3% and 0.7% respectively.

Surveillance of strongyloidiasis in Spanish in-patients (1998-2014).

BackgroundStrongyloides stercoralis is a parasite that causes strongyloidiasis, a neglected tropical disease. S. stercoralis is a soil-transmitted helminth that is widely distributed in tropical and subtropical regions of the world. Strongyloidiasis can occur without any symptoms or as a chronic infection characterized by mild, unspecific symptoms such as pruritus, abdominal pain or discomfort; respiratory impairment also may manifest as a potentially fatal hyperinfection or disseminated infection. Most studies on strongyloidiasis in Spain have been related to chronic forms in immigrants or travellers from endemic zones and have mainly analysed out-patient populations. Studies of the impact of strongyloidiasis cases admitted to hospitals in Spain are lacking. Therefore, the aim of this study was to analyse the impact of strongyloidiasis in hospital care in Spain.MethodologyWe designed a retrospective descriptive study using the Minimum Basic Data Set (MBDS, CMBD in Spanish) for inpatients with ICD-9: 127.2 (strongyloidiasis) diagnoses admitted to hospitals in the Spanish National Health System between 1998 and 2014.Principal findingsA total of 507 hospitalizations with diagnosis of strongyloidiasis were recorded, 324 cases (63.9%) were males. The mean (±SD) age was 42.1±20.1 years. The impact of strongyloidiasis on the total population of Spain was 0.06 cases per 105 person-years, and the infection burden increased progressively over time (from 0.01 cases per 105 person-years in 1999 to 0.10 cases per 105 person-years in 2014). 40 cases (7.9%) died. The total cost was approximately €8,681,062.3, and the mean cost per patient was €17,122.4±97,968.8.ConclusionsOur data suggest that strongyloidiasis is frequent in Spain and is increasing in incidence. Therefore, it would be desirable to improve the oversight and surveillance of this condition. Due to the fact that strongyloidiasis can be fatal, we believe that there is a need to establish risk categories for inclusion in national guidelines/protocols for screening individuals at risk of developing strongyloidiasis.

Bovine babesiosis: Cattle protected in the field with a frozen vaccine containing Babesia bovis and Babesia bigemina cultured in vitro with a serum-free medium

An attenuated live vaccine containing Babesia bovis and B. bigemina cultured in vitro with a serum-free medium was assessed for its clinical protection conferred of naïve cattle, under natural tick-challenge in a high endemicity zone to Babesia spp. Three groups of six animals were treated as follows: group I (GI) received a vaccine derived from parasites cultured with a free-serum medium; group II (GII) were immunized with the standard vaccine, with parasites cultured in a medium supplemented with 40% (v/v) bovine serum; and a control group (GIII) inoculated with non-infected bovine erythrocytes. Inocula were administered by IM route. Experimental animals were kept during 23days after vaccination in a cattle farm free of ticks and Babesia spp. Thereafter, cattle were moved to a high endemicity farm for natural exposure to Babesia spp. transmitted by Rhipicephalus microplus ticks. Protection against clinical babesiosis was observed in bovines belonging to GI (100%) and GII (83.33%), while the control animals (GIII) were not protected, and showed severe clinical signs, closely related to babesiosis, were observed for at least three consecutive days during the challenge. These were fever, anemia, which were measured simultaneously, and circulating parasites were detected by optic light microscopy. All cattle showed B. bovis and B. bigemina in stained blood films during the challenge; B. bovis antibody titers were higher than those to B. bigemina in GI and GII, and lower titers were determined in GIII. The protective capacity of the vaccine derived from B. bovis and B. bigemina cultured in vitro in a serum-free medium was demonstrated.

English

African horse sickness virus (AHSV) causes a non-contagious, infectious insect-borne disease of equids and it is endemic in many areas of sub-Saharan Africa but extends beyond its endemic zones to the Arabian Peninsula, Asia and Europe. The usual mode of transmission is by biting midge, a biological vector and Culicoides imicola appears to be the principal vector. Serum samples were screened from camels and donkeys for AHSV antibodies using competitive enzyme-linked immunosorbent assay (cELISA). Results revealed that 16/22 (73%) donkeys had been exposed to AHSV. All 85 camels screened in the study tested negative to AHSV. This was the first study of AHSV in Uganda and it was geared at creating awareness for the veterinary service needs of these animal species which is non-existent so far. Key words: African horse sickness virus (AHSV), Culicoides spp., camels, donkeys, Uganda.

Geochemical and isotopic evidences from groundwater and surface water for understanding of natural contamination in chronic kidney disease of unknown etiology (CKDu) endemic zones in Sri Lanka

ABSTRACTChronic kidney disease of unknown etiology (CKDu) is the main health issue in the dry zone of Sri Lanka. Despite many studies carried out, causative factors have not been identified yet clearly. According to the multidisciplinary researches carried out so far, potable water is considered as the main causative factor for CKDu. Hence, the present study was carried out with combined isotopic and chemical methods to understand possible relationships between groundwater; the main drinking water source, and CKDu in four endemic areas in the dry zone. Different water sources were evaluated isotopically (2H, 3H and 18O) and chemically from 2013 to 2015. Results revealed that prevalence of CKDu is significantly low with the groundwater replenished by surface water inputs. It is significantly high with the groundwater stagnated as well as groundwater recharged from regional flow paths. Thus, the origin, recharge mechanism and flow pattern of groundwater, as well as geological conditions which would be responsible for natural contamination of groundwater appear as the main causative factors for CKDu. Therefore, detailed investigations should be made in order to identify the element(s) in groundwater contributing to CKDu. The study recommends providing drinking water to the affected zones using water sources associated with surface waters.

The effect of alphacypermethrin-treated mesh protection against African horse sickness virus vectors on jet stall microclimate, clinical variables and faecal glucocorticoid metabolites of horses

BackgroundAfrican horse sickness (AHS) is of importance to health and international trade in horses worldwide. During export from and transit through AHS endemic countries or zones, physical and chemical measures to protect horses from the vectors of AHS virus (AHSV) are recommended by the World Organization for Animal Health. Protection of containerized air transport systems for horses (jet stalls) with alphacypermethrin insecticide-treated high density polyethylene mesh is effective in reducing the Culicoides midge vector attack rate. In order to determine the effect of this mesh on jet stall ventilation and horse welfare under temperate climatic conditions, jet stall microclimate, clinical variables and faecal glucocorticoid metabolite (FGM) levels of 12 horses were monitored during overnight housing in either a treated or untreated stall in two blocks of a 2 × 3 randomized crossover design.ResultsTemperature difference between the treated stall and outside was significantly higher than the difference between the untreated stall and outside at 1/15 time points only (P = 0.045, r = 0.70). Relative humidity (RH) difference between the treated stall and outside did not differ from the untreated stall and outside. Temperature and RH in the treated stall were highly and significantly correlated with outside temperature (r = 0.96, P < 0.001) and RH (r = 0.95, P < 0.001), respectively. No significant differences were detected between rectal temperatures, pulse and respiratory rates of horses in the treated stall compared to the untreated stall. Mean FGM concentrations for horses housed in the treated stall peaked earlier (24 h) and at a higher concentration than horses housed in the untreated stall (48 h), but were not significantly different from baseline. No significant difference was detected in FGM concentrations when the treated and untreated stall groups were compared at individual time points up to 72 h after exiting the jet stall.ConclusionsAlphacypermethrin-treated HDPE mesh could be used under temperate climatic conditions to protect horses in jet stalls against AHSV vectors, without compromising jet stall microclimate and horse welfare.

Delineation of an endemic tick paralysis zone in southeastern Australia

Tick paralysis has a major impact on pet dog and cat populations in southeastern Australia. It results from envenomation by Ixodes holocyclus and Ixodes cornuatus ticks, the role of Ixodes cornuatus in the epidemiology of this disease in Australia being unclear. The aim of this study was to describe the geographical distribution of tick paralysis cases in southeastern Australia using data from a national disease surveillance system and to compare characteristics of “endemic” cases with those reported outside this endemic zone (“sporadic” cases). Data were collated and a proportional symbol map of all cases by postcode was created. A 15-case isopleth was developed based on descriptive spatial statistics (directional ellipses) and then kernel smoothing to distinguish endemic from sporadic cases. During the study period (January 2010–December 2015) 12,421 cases were reported, and 10,839 of these reported by clinics located in 434 postcodes were included in the study. Endemic cases were predominantly reported from postcodes in coastal southeastern Australia, from southern Queensland to eastern Victoria. Of those cases meeting selection criteria, within the endemic zone 10,767 cases were reported from 351 (88%) postcodes and outside this zone 72 cases were reported from 48 (12%) postcodes. Of these latter 48 postcodes, 18 were in Victoria (26 cases), 16 in New South Wales (28 cases), 7 in Tasmania (9 cases), 5 in South Australia (7 cases) and 2 in Queensland (2 cases). Seasonal distribution in reporting was found: 62% of endemic and 52% of sporadic cases were reported in spring. The number of both endemic and sporadic cases reported peaked in October and November, but importantly a secondary peak in reporting of sporadic cases in April was found. In non-endemic areas, summer was the lowest risk season whilst in endemic areas, autumn was the lowest risk season. Two clusters of sporadic cases were identified, one in South Australia (P=0.022) during the period 22 May to 2 June 2012 and another in New South Wales (P=0.059) during the period 9 October to 29 November 2012. Endemic and sporadic cases did not differ with respect to neuter status (P=0.188), sex (P=0.205), case outcome (P=0.367) or method of diagnosis (P=0.413). However, sporadic cases were 4.2-times more likely to be dogs than cats (P<0.001). The endemic tick paralysis zone described is consistent with previous anecdotal reports. Sporadic cases reported outside this zone might be due to a history of pet travel to endemic areas, small foci of I. holocyclus outside of the endemic zone, or in the case of southern areas, tick paralysis caused by I. cornuatus.

Wild and domestic animals likely involved in rickettsial endemic zones of Northwestern Colombia

Between 2006 and 2008, three outbreaks of human rickettsiosis occurred in Northwestern Colombia (municipalities of Necoclí, Los Córdobas and Turbo), with case fatality rates between 27% and 54%. The aim of this study was to determine previous exposure of wild and domestic animals to spotted fever group (SFG) rickettsiae through serological tests, to detect rickettsial evidence in their ectoparasites, and to analyze their possible role in the epidemiology of rickettsial diseases in this zone of the country. A cross-sectional association study was performed from 2010 to 2011. Blood and ectoparasite samples were collected from domestic animals and small mammals. A statistically significant association (p<0.05) between seropositive animals and the study zones was observed. A total of 2937 ticks, 672 fleas and 74 lice were collected and tested in pools by PCR. The minimum infection rate (MIR) of the positive pools was 5% in ticks, 4% in fleas, and 0% in lice. Phylogenetic analyses showed circulation of three 4.Rickettsia species: R. felis in fleas, and R. bellii and Rickettsia sp. strain Atlantic rainforest, both in Amblyomma ovale ticks. In conclusion, this study demonstrated the occurrence of SFG rickettsiae in domestic, synanthropic and wild animals, and suggests the use of equines and canines as good sentinels of infection, in the study zone. We speculate that a transmission cycle exist involving rodents in the areas where these outbreaks have occurred. Tomes' spiny rats (Proechimys semispinosus) and common opossums (Didelphis marsupialis) could be good candidates as amplifier hosts for SFG rickettsiae in enzootic/endemic zones.

Lymphatic filariasis patient identification in a large urban area of Tanzania: An application of a community-led mHealth system.

BackgroundLymphatic filariasis (LF) is best known for the disabling and disfiguring clinical conditions that infected patients can develop; providing care for these individuals is a major goal of the Global Programme to Eliminate LF. Methods of locating these patients, knowing their true number and thus providing care for them, remains a challenge for national medical systems, particularly when the endemic zone is a large urban area.Methodology/Principle findingsA health community-led door-to-door survey approach using the SMS reporting tool MeasureSMS-Morbidity was used to rapidly collate and monitor data on LF patients in real-time (location, sex, age, clinical condition) in Dar es Salaam, Tanzania. Each stage of the phased study carried out in the three urban districts of city consisted of a training period, a patient identification and reporting period, and a data verification period, with refinements to the system being made after each phase. A total of 6889 patients were reported (133.6 per 100,000 population), of which 4169 were reported to have hydrocoele (80.9 per 100,000), 2251 lymphoedema-elephantiasis (LE) (43.7 per 100,000) and 469 with both conditions (9.1 per 100,000). Kinondoni had the highest number of reported patients in absolute terms (2846, 138.9 per 100,000), followed by Temeke (2550, 157.3 per 100,000) and Ilala (1493, 100.5 per 100,000). The number of hydrocoele patients was almost twice that of LE in all three districts. Severe LE patients accounted for approximately a quarter (26.9%) of those reported, with the number of acute attacks increasing with reported LE severity (1.34 in mild cases, 1.78 in moderate cases, 2.52 in severe). Verification checks supported these findings.Conclusions/SignificanceThis system of identifying, recording and mapping patients affected by LF greatly assists in planning, locating and prioritising, as well as initiating, appropriate morbidity management and disability prevention (MMDP) activities. The approach is a feasible framework that could be used in other large urban environments in the LF endemic areas.